Influence of suture material and surgical technique on risk of reoperation after non-mesh open hernia repair (Br J Surg 2003; 90: 1004–1008)

Sir In developing countries like India the price of mesh is a major constraint for poor patients undergoing hernia repair in public hospitals, despite the fact that the cost is reducing. Myoaponeurotic hernia repairs like Shouldice and the modified Bassini are widely used instead. The authors of this article have demonstrated the benefit of non-absorbable sutures in open non-mesh hernia repair. We did a retrospective study of 253 patients who underwent modified Bassini hernia repair to compare interrupted suturing to continuous suturing of the posterior wall with non-absorbable sutures. Nineteen (20·2 per cent) of the 113 patients who had continuous suturing to the posterior wall developed a recurrence compared to 12 (9·4 per cent) of the 140 patients who had interrupted sutures. The high recurrence rate was probably due to the fact that most of these patients come from a low socio-economic group (manual labourers) and go back to work very early after surgery due to social pressure. When continuous suturing is used, if only one suture cuts through after the operation, the whole of the posterior wall becomes weak, leading to early recurrence. Using interrupted sutures should avoid this situation and therefore influence recurrence rates in open non-mesh hernia repair.